Assessment of treatment response to splint therapy and evaluation of TMJ function using joint vibration analysis in patients exhibiting TMJ disc displacement with reduction: A clinical study

Abstract

Context, Aim, and Objectives: Diagnosis of temporomandibular joint (TMJ) disc displacement with reduction (DDR) is difficult. Literature combining different subjective parameters of TMJ function with an objective evaluation of TMJ function using joint vibration analysis (JVA) is limited. Hence, the study was planned to diagnose temporomandibular disorder accurately, to do a subjective and objective evaluation of TMJ function, and to assess the effectiveness of different types of splint therapy over the conventional anterior repositioning appliance (ARA) group. Design: Single-blind, randomized, comparative clinical trial conducted in thirty patients, 18–55 years of age, allocated to three groups, i.e., ARA conventional group, centric stabilization splint (CSS), and Soft splint (SS) groups. Subjects and Methods: Preoperative values of comfortable mouth opening (CMO) in mm, maximum mouth opening (MMO) in mm, TMJ clicking and tenderness (grading 0–3), visual analog scale pain score (0–10 cm), and total energy (TE) integral values of both TMJs using JVA were recorded. Postoperative values were taken at the time of delivery of splint at 1st, 2nd, 6th, and 10th week. Statistical Analysis and Results: Intergroup comparison – Kruskal–Wallis test showed no statistically significant difference in CMO, MMO, and TE values of right TMJs among three groups at any point. No significant difference was seen in TMJ clicking and tenderness among groups at any point of time except at 10 weeks and at 2 weeks, respectively, by Chi-square test. Intragroup comparison - Wilcoxon signed-rank test showed the significance of difference (P < 0.05*) in postoperative visits for CMO, MMO, pain score, and TE values. Clinical effect size, extent, consistency, and percentage of cases showing improvement were maximum for CSS group. Conclusions: The study concludes that the use of JVA for diagnosis along with history and clinical examination increases the accuracy of the diagnosis of DDR. ARA group was used as a conventional treatment option. Although statistically significant difference in pre- and post-treatment values was obtained in all the three groups, CSS group patients showed consistent clinically effective responses and more significant improvement in the subsequent follow-up visits than SS group. Hence, it is advisable to start therapy with CSS splint in TMJ DDR patients to get sooner and effective results without minimum side effects.

Keywords

• Clicking
• disc displacement
• pain
• splints
• temporomandibular disorder
• vibration